Παρασκευή 10 Νοεμβρίου 2017
Reintroducing the Sodium–Iodide Symporter to Anaplastic Thyroid Carcinoma
Thyroid , Vol. 0, No. 0.
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Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory
Thyroid , Vol. 0, No. 0.
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Honor our veterans: Cold War, warm dentist
Decades before his private practice, he was part of a three-man dental clinic on a Royal Air Force base in Scotland, practicing his trade on men who were gathering intelligence on the Russians. Drake retired in 1984 from the Navy a captain after 24 years of service and moved with his wife Mary to Buena Vista, having been introduced to the Spring Canyon Christian Fellowship by a fellow officer.
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Surgical approaches to the mitral valve: variable paths to the same destination
Abstract
Surgical exposure to access mitral valve has been performed through various chambers in the heart like left atrium, right atrium and trans septal approach, through ascending aorta and left ventricle as well. Depending upon the surgical pathology, body habitus of the patient, and previous cardiac surgery, each approach has some advantages and disadvantages. This article reviews all the approaches and the surgical indications as well the advantages and disadvantages of the each approach.
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Evolving concepts in lung cancer pathology and its impact on thoracic oncology practice
Abstract
Lung cancer is the commonest cause of death worldwide but unfortunately, most patients present in an advanced stage of the disease. The classification of lung cancer has evolved since the first WHO publication in 1981, and the present edition was published in March 2015. A major change in 2015 was the introduction of the new terms adenocarcinoma in situ and minimally invasive adenocarcinoma to describe early adenocarcinoma of lung and abolition of the previous term bronchioloalveolar carcinoma. Tumors with micropapillary pattern and those showing spread through alveolar spaces have significant clinical implications with an increased propensity for recurrence. Tissue specimens require proper fixation in 10% buffered formalin which is an essential but an often neglected basic step; proper fixation is a prerequisite for good immunohistochemistry (IHC) and molecular test outcomes. Needle core biopsies should be handled judiciously to ensure that sufficient material is prioritized for molecular studies which are needed to guide personalized treatment. The WHO 2015 classification recommends the use of a single squamous cell marker (p40, or CK5/6) and a single adenocarcinoma marker (TTF1, or napsin) to distinguish squamous cell carcinoma and adenocarcinoma in difficult biopsies. The non-committal designation of non-small cell lung carcinoma (NSCLC) is discouraged. The exciting ongoing research findings on molecular biology of lung cancer necessitate constant expansion of laboratory test menu. Testing and treating lung cancer patients with epidermal growth factor (EGFR) mutation and anaplastic lymphoma kinase (ALK) gene fusion is now a standard of care, and ROS1 has been approved recently. The updated guidelines from the College of American Pathologists (CAP) and approval notifications from the Federal Drug Authority (FDA) are invaluable to justify initiation of new tests by pathology laboratories. Recently, FDA has approved testing for programmed death ligand (PDL1) with 22C3 antibody by IHC and EGFR testing on plasma by a non-invasive liquid biopsy test approach. To conclude, a comprehensive pathology report is vital for staging, comparing outcomes, and developing better strategies for patient care in the future.
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Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance.
The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P
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Firm Elevation of Reconstructed Auricle Using Polydactyly Digit in Microtia.
Total ear reconstruction for microtia is usually accomplished in 2 stages which is known as Nagata technique. After framework fabrication and implantation, the elevation procedure is required as a second step surgery. The authors are introducing a novel material for augmenting projection of rib cartilage framework in microtia treatment. (C) 2017 by Mutaz B. Habal, MD.
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Valgus Hindfoot Deformity Secondary to Neonatal Intravenous Infiltration.
Orthopedic complications of intravenous (IV) infiltration are rare, with only a handful of cases reported in the literature. Because of the relatively high rate of IV infiltration in neonates, however, such complications do occur and can include growth arrest, limb length discrepancy, and joint deformities that require surgical intervention. The risk of these complications is highest in preterm neonates. A 7-year-old girl presented to our institution with a severe valgus hindfoot deformity that developed secondary to a neonatal IV infiltration injury. Management consisted of a medial displacement calcaneal osteotomy followed 5 years later by a triple arthrodesis, Strayer procedure, and free flap transfer. (C) 2017 by Mutaz B. Habal, MD.
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Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures.
Purpose: Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD. Methods: This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue. Results: Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD +/- $22205.09) versus $35826.00 (SD +/- $23509.93) for modified titanium mesh implants and $46547.90 (SD +/- 81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387). Conclusion: Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction. (C) 2017 by Mutaz B. Habal, MD.
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Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia.
Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. Methods: Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. Results: Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). Conclusions: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure. (C) 2017 by Mutaz B. Habal, MD.
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Strengthening Evidence in Cleft and Craniofacial Surgery.
No abstract available
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A Novel Secretome Biotherapeutic Influences Regeneration in Critical Size Bone Defects.
Severe traumatic injuries often result in critical size bone defects, which are unable to heal without treatment. Autologous grafting is the standard of care but requires additional surgeries for graft procurement. Amnion-derived multipotent progenitor cells release a secretome of biomolecules identified as integral to the process of bone regeneration and angiogenesis. This secretome is currently under development as a biotherapeutic. The efficacy of this secretome biotherapeutic was evaluated in vitro on the proliferation and migration of mesenchymal stem cells and osteoprogenitor cells as well as in vivo using a critical size rat calvarial defect model. The secretome biotherapeutic was loaded onto a collagen scaffold and placed into the defect, which was allowed to heal for 4 and 12 weeks. The secretome biotherapeutic enhanced the proliferation and migration of mesenchymal stem cells and proliferation of osteoprogenitor cells. Further, the secretome biotherapeutic improved new bone volume and connectivity by 12 weeks and significantly improved angiogenesis at 4 weeks and bone density at 4 and 12 weeks with no deleterious effects. The improvement in new bone volume, connectivity, and angiogenesis suggests that the secretome biotherapeutic has beneficial effects for bone healing and a higher dose of the secretome biotherapeutic may further improve regeneration. (C) 2017 by Mutaz B. Habal, MD.
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Drug Release: Proper Control to Help Clinical Application.
No abstract available
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Review of "Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program" by Liu JB, Berian JR, Ban KA, Liu Y, Cohen ME, Angelos P, Matthews JB, Hoyt DB, Hall BL, Ko CY in Ann Surg 266:411-420, 2017.
No abstract available
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Treatment of Maxillary Hypoplasia in Cleft Lip and Palate: Segmental Distraction Osteogenesis With Hyrax Device.
The objective of this work is to describe a segmental maxillary distraction osteogenesis (SDO) with segmental Lefort I with an inexpensive device. Four patients who presented severe class III and maxillary hypoplasia due to cleft lip and palate sequel were treated. A SDO was performed using a dental-anchored Hyrax device, achieving enlargement of the upper jaw without altering speech, with adequate and stable occlusion. Dental implants in a new formed bone were installed. The authors can conclude that SDO is a good treatment alternative for patients with maxillary hypoplasia. It preserves velopharyngeal function and is a stable treatment, maintaining the overjet achieved with distraction osteogenesis, without changes in posterior occlusion. The open bite generated with tooth-borne devices can be solved with temporary anchorage devices and intermaxillary elastics during consolidation phase. Modified Hyrax device allows expanding and moving forward the maxillary arch, with a low cost. (C) 2017 by Mutaz B. Habal, MD.
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Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position.
There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors' best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia. (C) 2017 by Mutaz B. Habal, MD.
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A Personal Approach to Bilateral Cleft Lip Repair.
Dr Michael B. Lewis has been using his personal approach to bilateral cleft lip (BCL) repair for 30 years to achieve a loose, pouting upper lip, a 90-degree columellar-labial angle, and a projecting nasal tip. This article describes technique and results. (C) 2017 by Mutaz B. Habal, MD.
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Use of Acellular Dermal Matrix in Craniosynostosis.
In craniofacial surgery, a wide spectrum of pathological conditions are usually treated. The aetiology of these could be congenital, traumatic, infective, post-tumor resection, postradiation, autoimmune, iatrogenic, or other miscellaneous conditions. The surgical approach for the procedures is usually via a coronal incision. In a large proportion of the patients, the frontal bone is removed to obtain intracranial access. The frontal bone is then replaced either in its original form or in a remodeled state. In congenital conditions the supraorbital bar and frontal bone is often also removed, remodeled, and replaced. One of the common late sequelae following craniofacial surgery is contour irregularities of the frontal region. These irregularities can vary in their extent. They are invariably palpable and often visible. Surgeons have attempted various methods to improve the contour irregularities. Despite these measures contour irregularities can still ensue. In the authors' unit, the authors have been using acellular dermal matrix in an attempt to diminish the contour irregularities in the frontal region following craniofacial reconstruction for craniosynostosis. This has been used in 35 patients undergoing craniosynostosis correction. Of the 35 patients, 12 were for plagiocephaly, 7 for brachycephaly, 10 for scaphocephaly, 4 for trigonocephaly, and 2 for combined coronal and metopic synostosis. The age of the patients ranged from 5 months to 12 years (mean 20.5 months). There were 21 males and 14 females. The follow-up ranged from 10 to 48 months (mean 23 months). (C) 2017 by Mutaz B. Habal, MD.
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Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate.
The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement ([DELTA]A-vertical reference plane, 4.8 mm, P 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage. (C) 2017 by Mutaz B. Habal, MD.
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Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws.
The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact. The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported. Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment. (C) 2017 by Mutaz B. Habal, MD.
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Trial registry searches for RCTs of new drugs required registry-specific adaptation to achieve adequate sensitivity
Source:Journal of Clinical Epidemiology
Author(s): Marco Knelangen, Elke Hausner, Maria-Inti Metzendorf, Sibylle Sturtz, Siw Waffenschmidt
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The proposed ‘concordance-statistic for benefit’ provided a useful metric when modeling heterogeneous treatment effects
Source:Journal of Clinical Epidemiology
Author(s): David van Klaveren, Ewout W. Steyerberg, Patrick W. Serruys, David M. Kent
ObjectivesClinical prediction models that support treatment decisions are usually evaluated for their ability to predict the risk of an outcome rather than treatment benefit – the difference between outcome risk with versus without therapy. We aimed to define performance metrics for a model's ability to predict treatment benefit.Study Design and SettingWe analyzed data of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, and of 3 recombinant tissue plasminogen activator trials. We assessed alternative prediction models with a conventional risk concordance-statistic (c-statistic) and a novel c-statistic for benefit. We defined observed treatment benefit by the outcomes in pairs of patients matched on predicted benefit but discordant for treatment assignment. The 'c-for-benefit' represents the probability that from two randomly chosen matched patient pairs with unequal observed benefit, the pair with greater observed benefit also has a higher predicted benefit.ResultsCompared to a model without treatment interactions, the SYNTAX Score II had improved ability to discriminate treatment benefit (c-for-benefit 0.590 versus 0.552), despite having similar risk discrimination (c-statistic 0.725 versus 0.719). However, for the simplified Stroke-Thrombolytic Predictive Instrument (TPI) versus the original Stroke-TPI, the c-for-benefit (0.584 versus 0.578) was similar.ConclusionThe proposed methodology has the potential to measure a model's ability to predict treatment benefit not captured with conventional performance metrics.
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Table of Contents
Publication date: October 2017
Source:Journal of Clinical Epidemiology, Volume 90
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Recommendations for primary studies evaluating therapeutic medical devices were identified and systematically reported through reviewing existing guidance
Source:Journal of Clinical Epidemiology
Author(s): Petra Schnell-Inderst, Theresa Hunger, Annette Conrads-Frank, Marjan Arvandi, Uwe Siebert
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Using reference values to define disease based on the lower limit of normal biased the population attributable fraction, but not the population excess risk: the example of chronic airflow obstruction
Source:Journal of Clinical Epidemiology
Author(s): Peter Burney, Cosetta Minelli
The impact of disease on population health is most commonly estimated by the population attributable fraction (PAF). This measurement, an estimate of the proportion of the disease in the population that is attributable to the exposure, is sensitive to the way that the disease is defined. When disease is defined from reference values that are derived from the distribution of values in the "normal" population the PAF is difficult to interpret. Using measures of chronic airflow obstruction as an example, we demonstrate that where normality is defined by centiles (or fractiles) of values in a "normal" population, PAF is strongly influenced by which centile is selected to define normality. This is not true for the population excess risk, an alternative measure of disease impact that estimates the absolute risk of disease in the population that can be ascribed to the exposure. Care should be taken when interpreting estimates of PAF when disease is defined from a centile of a normal population.
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Characterization of gastrointestinal adverse effects reporting in clinical studies of corticosteroid therapy
Source:Journal of Clinical Epidemiology
Author(s): Tone Westergren, Sigrid Narum, Marianne Klemp
ObjectiveTo examine whether 159 studies included in a previous meta-analysis reported on gastrointestinal bleeding or perforation in accordance with the the CONSORT extension for reporting harms outcomes (CONSORT Harms recommendations checklist), whether differences were associated with funding source, journal or publication year, and whether the CONSORT Harms checklist is a suitable tool for evaluation of adverse effects reporting.Study Design and SettingArticles were assessed for fulfilment of the CONSORT Harms recommendations, funding source, publication type and year. Agreement between reviewers was assessed by comparing scores for each study.ResultsThe mean CONSORT Harms score was 5.25 out of 10 (SD ± 2.09). Most studies included information on participant withdrawals (133 studies, 83.6%), absolute risk of gastrointestinal bleeding or perforation (130 studies, 81.8%), and how harms-related information was collected (118 studies, 74.2%). Reporting of gastrointestinal bleeding or perforation increased with higher scores (OR 1.173, p=0.042).There was no significant association between CONSORT Harms score achieved and publication year or funding source, but there was a trend towards higher scores in studies published in the major medical journals (score difference 0.78, P=0.052). Definitions of gastrointestinal bleeding differed between studies. Reviewer agreement was fair to moderate with large variations.ConclusionFew studies in the systematic review received high scores using the CONSORT Harms criteria. Most studies reported on the most important criteria regarding risk of gastrointestinal bleeding or perforation. Reviewer agreement showed large variations due to imprecise texts and ambiguous criteria. Routine scoring according to fulfilment of the CONSORT Harms recommendations would be inadvisable without qualified judgment.
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Reproducible research practices are underused in systematic reviews of biomedical interventions
Source:Journal of Clinical Epidemiology
Author(s): Matthew J. Page, Douglas G. Altman, Larissa Shamseer, Joanne E. McKenzie, Nadera Ahmadzai, Dianna Wolfe, Fatemeh Yazdi, Ferrán Catalá-López, Andrea C. Tricco, David Moher
ObjectivesTo evaluate how often reproducible research practices, which allow others to recreate the findings of studies, given the original data, are used in systematic reviews (SRs) of biomedical research.Study Design and SettingWe evaluated a random sample of SRs indexed in MEDLINE® during February 2014, which focused on a therapeutic intervention and reported at least one meta-analysis. Data on reproducible research practices in each SR were extracted using a 26-item form by one author, with a 20% random sample extracted in duplicate. We explored whether the use of reproducible research practices was associated with a SR being a Cochrane review, as well as with the reported use of the PRISMA Statement.ResultsWe evaluated 110 SRs of therapeutic interventions, 78 (71%) of which were non-Cochrane SRs. Across the SRs there were 2,139 meta-analytic effects (including subgroup meta-analytic effects and sensitivity analyses), 1,551 (73%) of which were reported in sufficient detail to recreate them. Systematic reviewers reported the data needed to recreate all meta-analytic effects in the SR in 72 (65%) SRs only. This percentage was higher in Cochrane than in non-Cochrane SRs (30/32 [94%] versus 42/78 [54%]; risk ratio 1.74, 95% confidence interval 1.39-2.18). Systematic reviewers who reported imputing, algebraically manipulating, or obtaining some data from the study author/sponsor infrequently stated which specific data were handled in this way. Only 33 (30%) SRs mentioned access to datasets and statistical code used to perform analyses.ConclusionsReproducible research practices are underused in SRs of biomedical interventions. Adoption of such practices facilitates identification of errors and allows the SR data to be re-analysed.
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The split-plot design was useful for evaluating complex, multi-level interventions but there is need for improvement in its design and report
Source:Journal of Clinical Epidemiology
Author(s): Beatriz Goulão, Graeme MacLennan, Craig Ramsay
ObjectiveTo describe the sample size calculation, analysis and reporting of split-plot randomised controlled trials (RCT) in healthcare (trials that use two units of randomisation: one at a cluster-level and one at a level lower than the cluster).Study Design and SettingWe carried out a comprehensive search in the EMBASE database from 1946 to 2016. Healthcare trials with a split-plot design in human subjects were included. Three authors screened and assessed the studies and data were extracted on methodology and reporting standards based upon CONSORT.Results18 split-plot studies were included, with authors using nine different designations to describe them. Units of randomisation were unclear in nine abstracts. Explicit rationale for choosing the design was not givenTen studies presented a sample size calculation accounting for clustering; the analyses were coherent with that. Flow of participant diagrams were presented but incomplete in 14 articles.ConclusionSplit-plot designs can be useful complex designs, but challenging to report. Researchers need to clearly describe the rationale, sample size calculation and participant flow. We provide a suggested CONSORT style participant flow diagram to aid reporting. There is need for more research regarding sample size calculation for split-plots.
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Use of the PRECIS-II instrument to categorize reports along the efficacy-effectiveness spectrum in an hepatitis C virus care continuum systematic review and meta-analysis
Source:Journal of Clinical Epidemiology
Author(s): Ashly E. Jordan, David C. Perlman, Daniel J. Smith, Jennifer R. Reed, Holly Hagan
There is increasing recognition of the importance of the distinction between efficacy and effectiveness research in the design, conduct, and evaluation of interventions and program outcomes. There is a concurrent increase in the application of systematic reviews and meta-analyses. These two lines of inquiry are only beginning to meet. There is an emerging need for systematic reviews and meta-analyses to account for differences in degrees to which included studies reflect either efficacy and effectiveness designs. Based on on-going work on a formal systematic review of the hepatitis C virus care continuum, this paper describes and discusses the rationale for, and how the PRECIS-II instrument can be used on, and modestly adapted to, studies included in the systematic review examining the extent to which studies include elements of efficacy or effectiveness, or a combination of the two. We also highlight that use of such an instrument may have general applicability to and value in the conduct of systematic reviews and meta-analysis.
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Explaining Odds Ratios as Conditional Risk Ratios
Source:Journal of Clinical Epidemiology
Author(s): Fred M. Hoppe, Daniel J. Hoppe, Stephen D. Walter
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Association between prospective registration and overall reporting and methodological quality of systematic reviews: a meta-epidemiological study
Source:Journal of Clinical Epidemiology
Author(s): Long Ge, Jin-hui Tian, Ya-nan Li, Jia-xue Pan, Ge Li, Dang Wei, Xin Xing, Bei Pan, Yao-long Chen, Fu-jian Song, Ke-hu Yang
ObjectiveTo investigate the differences in main characteristics, reporting and methodological quality between prospectively registered and non-registered systematic reviews.MethodsPubMed was searched to identify systematic reviews of randomized controlled trials published in 2015 in English. After title and abstract screening, potentially relevant reviews were divided into three groups: registered non-Cochrane reviews, Cochrane reviews, and non-registered reviews. For each group, random number tables were generated in Microsoft Excel, and the first 50 eligible studies from each group were randomly selected. Data of interest from systematic reviews were extracted. Regression analyses were conducted to explore the association between total R-AMSTAR or PRISMA scores and the selected characteristics of systematic reviews.ResultsThe conducting and reporting of literature search in registered reviews were superior to non-registered reviews. Differences in nine of the 11 R-AMSTAR items were statistically significant between registered and non-registered reviews. The total R-AMSTAR score of registered reviews was higher than non-registered reviews (MD=4.82, 95%CI: 3.70, 5.94). Sensitivity analysis by excluding the registration related item presented similar result (MD=4.34, 95%CI: 3.28, 5.40). Total PRISMA scores of registered reviews were significantly higher than non-registered reviews (all reviews: MD=1.47, 95%CI: 0.64-2.30; non-Cochrane reviews: MD=1.49, 95%CI: 0.56-2.42). However, the difference in the total PRISMA score was no longer statistically significant after excluding the item related to registration (item 5). Regression analyses showed similar results.ConclusionsProspective registration may at least indirectly improve the overall methodological quality of systematic reviews, although its impact on the overall reporting quality was not significant.
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Cluster-randomised controlled trials evaluating complex interventions in general practices are mostly ineffective: A systematic review
Source:Journal of Clinical Epidemiology
Author(s): Andrea Siebenhofer, Michael A. Paulitsch, Gudrun Pregartner, Andrea Berghold, Klaus Jeitler, Christiane Muth, Jennifer Engler
ObjectiveTo evaluate how frequently complex interventions are shown to be superior to routine care in general practice-based cluster-randomised studies (c-RCTs), and to explore whether potential differences explain results that come out in favour of a complex intervention.Study DesignWe performed an unrestricted search in the Central Register of Controlled Trials, MEDLINE and EMBASE. Included were all c-RCTs that included a patient-relevant primary outcome in a general practice setting with at least one-year follow-up. We extracted effect sizes, p-values, intra-cluster correlation coefficients (ICCs) and 22 quality aspects.ResultsWe identified 29 trials with 99 patient-relevant primary outcomes. After adjustment for multiple testing on a trial level, four outcomes (4%) in four studies (14%) remained statistically significant. Of the eleven studies that reported ICCs, in eight the ICC was equal to or smaller than the assumed ICC. In 16 of the 17 studies with available sample-size calculation, effect sizes were smaller than anticipated.ConclusionsMore than 85% of the c-RCTs failed to demonstrate a beneficial effect on a pre-defined primary endpoint. All but one study were overly optimistic with regard to the expected treatment effect. This highlights the importance of weighing up the potential merit of new treatments and planning prospectively, when designing clinical studies in a general practice setting.
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A clarification on odds ratios as conditional risk ratios
Source:Journal of Clinical Epidemiology
Author(s): Federico Tedeschi
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Editorial Board
Publication date: October 2017
Source:Journal of Clinical Epidemiology, Volume 90
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Comparable outcomes among trial and non-trial participants in a clinical trial of antibiotics for childhood pneumonia: A retrospective cohort study
Source:Journal of Clinical Epidemiology
Author(s): Ambrose Agweyu, Jacquie Oliwa, David Gathara, Naomi Muinga, Elizabeth Allen, Richard J. Lilford, Mike English
ObjectiveWe compared characteristics and outcomes of children enrolled in a randomized controlled trial (RCT) comparing oral amoxicillin and benzyl penicillin for the treatment of chest indrawing pneumonia versus children who received routine care to determine the external validity of the trial results.Study Design and SettingWe undertook a retrospective cohort study of children aged 2 – 59 months admitted in six Kenyan hospitals. Data for non-trial participants were extracted from inpatient records upon conclusion of the RCT. Mortality among trial versus non-trial participants was compared in multivariate models.Results1709 children were included, of whom 527 were enrolled in the RCT and 1182 received routine care. History of a wheeze was more common among trial participants (35.4% versus 11.2%; p<0.01), while dehydration was more common among non-trial participants (8.6% versus 5.9%; p=0.05). Other patient characteristics were balanced between the two groups. Among those with available outcome data, 14/1140 (1.2%) non-trial participants died compared to 4/527 (0.8%) enrolled in the trial (adjusted odds ratio 0.7; 95% confidence interval 0.2 to 2.1).ConclusionPatient characteristics were similar and mortality was low among trial and non-trial participants. These findings support the revised World Health Organization treatment recommendations for chest indrawing pneumonia.
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Addressing complexity in health research, a big issue
Source:Journal of Clinical Epidemiology, Volume 90
Author(s): J. André Knottnerus, Peter Tugwell
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Self-Reported Medication Use Validated Through Record Linkage to National Prescribing Data
Source:Journal of Clinical Epidemiology
Author(s): J.D. Hafferty, A.I. Campbell, L.B. Navrady, M.J. Adams, D. MacIntyre, S.M. Lawrie, K. Nicodemus, D.J. Porteous, A.M. McIntosh
ObjectiveResearchers need to be confident about the reliability of epidemiological studies that quantify medication use through self-report. Some evidence suggests that psychiatric medications are systemically under-reported. Modern record linkage enables validation of self-report with national prescribing data as gold standard. Here, we investigated the validity of medication self-report for multiple medication types.Study Design and SettingParticipants in the Generation Scotland population-based cohort (N=10,244) recruited 2009-11 self-reported regular usage of several commonly prescribed medication classes. This was matched against Scottish NHS prescriptions data using three- and six-month fixed time windows. Potential predictors of discordant self-report, including general intelligence and psychological distress, were studied via multivariate logistic regression.ResultsAntidepressants self-report showed very good agreement (κ=0.85, (95% Confidence Interval (CI) 0.84-0.87)), comparable to antihypertensives (κ=0.90, (0.89-0.91)). Self-report of mood stabilizers showed moderate-poor agreement (κ=0.42 CI 0.33-0.50). Relevant past medical history was the strongest predictor of self-report sensitivity, whereas general intelligence was not predictive.ConclusionIn this large population-based study, we found self-report validity varied among medication classes, with no simple relationship between psychiatric medication and under-reporting. History of indicated illness predicted more accurate self-report, for both psychiatric and non-psychiatric medications. Although other patient-level factors influenced self-report for some medications, none predicted greater accuracy across all medications studied.
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Ten recommendations for assessing the comparative effectiveness of therapeutic medical devices: A targeted review and adaptation
Publication date: Available online 28 October 2017
Source:Journal of Clinical Epidemiology
Author(s): Petra Schnell-Inderst, Theresa Hunger, Annette Conrads-Frank, Marjan Arvandi, Uwe Siebert
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Editorial Board
Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Future and recent issues
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Information for authors
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Sleep Dentists Win Big With Project Rose
Project Rose Team: Gary Baxter, Dr. Rebecca Lauck, Dr. Brandon Hedgecock, Isiah Robertson, Dr. Harry Sugg, D. Gergen, Dr. Ed Hobbs, Eric Dickerson
As a country, we have satisfaction in being American, but each community also value's their own individual cultures. The American Sleep and Breathing Academy (ASBA) wants to release an official statement of support and pride for the communities in Florida and surrounding areas as well as Houston communities effected by Hurricane Harvey and Hurricane Irma. With different disasters in different areas come different recoveries but, nevertheless, recovery is inevitable.
The resilience of the communities damaged are stunning and marvelous, but not shocking. It is especially magnificent to see Houston rally behind the Houston Astros, major league contenders for the championship of America's pastime, and NFL legend/Rose of Texas Earl Campbell's Project Rose, a project dedicated to enhancing the safety of sports and improving sleep and wellness in communities throughout the country. After the devastating hurricane, Earl Campbell and Gary Baxter wanted to focus on adding to the local economy in Houston. They are doing so by launching sleep and wellness programs in 17 hospitals/clinics throughout Houston.
The wellness program is designed with an emphasis on preventive care and a healthier lifestyle. An ounce of prevention can save a pound of problems. That's why Project Rose Wellness Program is proudly offering the next generation of innovative lab testing, food/nutrition education, mental and physical health exercises, and providing a unique approach to understanding everyone's lifestyle requirements for better health.
Strengthening the ties of communities adds to the fortitude and unity of the entire country. The American Sleep and Breathing Academy thanks everyone involved for their contribution and unwavering capacity to recover quickly from difficult times.
Call David Gergen at 602-478-9713 to see how you can become involved.
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The spillover influence of partner's education on myocardial infarction incidence and survival.
Background: Education is believed to have positive spillover effects across network connections. Partner's education may be an important resource preventing the incidence of disease and helping patients cope with illness. We examined how partner's education predicted myocardial infarction (MI) incidence and survival net of own education and other socioeconomic resources in Finland. Methods: A sample of adults aged 40-69 at baseline in Finland in 1990 was followed up for MI incidence and mortality during the period 1991-2007 (n=354,100). Results: Lower own and spousal education both contributed independently to a higher risk of MI incidence and fatality when mutually adjusted. Having a partner with basic education was particularly strongly associated with long-term fatality in women with a hazard ratio of 1.53 (95% confidence interval 1.22, 1.92) compared to women with tertiary level educated partners. There was some evidence that the incidence risk associated with basic spousal education was weaker in those with own basic education. The highest risks of MI incidence and fatality were consistently found in those without a partner, whereas the most favorable outcomes were in households where both partners had a tertiary level of education. Conclusions: Accounting for spousal education demonstrates how health-enhancing resources accumulate to some households. Marriage between people of similar educational levels may therefore contribute to the widening of educational differences in MI incidence and survival. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Validation of Cancer Cases Using Primary Care, Cancer Registry, and Hospitalization Data in the UK.
Background: In the United Kingdom, hospital or cancer registry data can be linked to electronic medical records for a subset of general practices and years. Methods: We used Clinical Practice Research Datalink data (2004-2012) from patients treated for overactive bladder. We electronically identified provisional cases of 10 common cancers in General Practitioner Online Database data and validated them by medical profile review. In practices with linkage to Hospital Episodes Statistics and National Cancer Data Repository (2004-2010), we validated provisional cancer cases against these data sources. This linkage also let us identify additional cancer diagnoses in individuals without cancer diagnosis records in the General Practitioner Online Database. Results: Among 50,840 patients, 1,486 provisional cancer cases were identified in the General Practitioner Online Database for 2004-2012. Medical profile review confirmed 93% of 661 cases in non-linked practices (range, 100% of non-Hodgkin lymphomas and uterine cancer to 77% of skin melanomas) and 96% of 825 cases in linked practices (100% of kidney and uterine cancers to 92% of melanomas). In the subset of linked practices, for 2004-2010, 720 cases were confirmed, of which 68% were identifiable in the General Practitioner Online Database (range, 90% of breast to 36% of kidney cancers). Conclusions: Most cases of cancer identified electronically in the General Practitioner Online Database were confirmed. A substantial proportion of cases, especially of cancer types not typically managed by general practitioners, would be missed without Hospital Episodes Statistics and National Cancer Data Repository data (and are likely missed in non-linked practices). Registration (before study conduct): European Union electronic Register of Post-Authorisation Studies (EU PAS Registry) number EUPAS5529, http://ift.tt/2zwWaYK This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Exposure to passive smoking and impairment in physical function in older people.
No abstract available
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Yorgo Foods Inc is Recalling Various Flavors of Hommus Because of Possible Health Risk
Yorgo Foods Inc of Manchester NH, is recalling select varieties of Hommus and Baba Ghannouj, because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.
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Eine seltene Differentialdiagnose des supraglottischen Larynxödems
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121343
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Left parasternal approach for Bentall procedure in a patient of Marfan syndrome with severe pectus excavatum
Abstract
Annuloaortic ectasia with ascending aortic aneurysm with severe aortic regurgitation with severe left ventricular dysfunction is a serious condition especially in patients with Marfan syndrome (MFS) simultaneously having severe pectus excavatum (PE) deformity. We report our left parasternal approach in such patient in whom median sternotomy was not feasible. We achieved excellent exposure of dislocated heart and great vessels enabling Bentall procedure. Since patient did not consent for combined correction of chest wall deformity, we plan to undertake it later. Therefore, we conclude that left parasternal approach is feasible for standard aortic root replacement surgery in severe PE.
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Transcatheter mitral valve replacement
Abstract
Mitral valve disease is a growing clinical problem. Surgical mitral valve repair and replacement remains the treatment of choice with excellent long-term clinical outcomes. However, a large number of symptomatic patients were deemed too high-risk undergoing surgical correction. Catheter-based technology has been in development to address this unmet need. Transcatheter mitral valve replacement devices are such technology and are currently undergoing clinical investigation. A systematic overview is being presented in the article.
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In-vitro comparison of mechanical resistance between two straight plates and a Y-plate for fixation of mandibular condyle fractures
To compare the mechanical resistance of conventional plates with a modified Y-plate in mandibular condyle fracture.
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Tailored resections in oral and oropharyngeal cancer using narrow band imaging
In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.
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Using simulators to teach pediatric airway procedures in an international setting
There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology.
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Hearing loss in children with primary ciliary dyskinesia
To evaluate the type and severity of hearing impairment in pediatric patients with primary ciliary dyskinesia (PCD) and relate these measures to patient demographics, treatment options, and other otologic factors.
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In-continuity neck dissection: long-term oncological outcomes in squamous cell carcinoma of the buccal mucosa
To introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients.
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The proposed ‘concordance-statistic for benefit’ provided a useful metric when modeling heterogeneous treatment effects
Clinical prediction models that support treatment decisions are usually evaluated for their ability to predict the risk of an outcome rather than treatment benefit – the difference between outcome risk with versus without therapy. We aimed to define performance metrics for a model's ability to predict treatment benefit.
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Dr. Harry Sugg: Supporting an Academy That Fights on Your Behalf
NFL Legend Eric Dickerson, David Gergen, Dr. Harry Sugg
When considering the political/NFL ties the American Sleep and Breathing Academy (ASBA) holds, value in being a member and advantages over non-members certainly becomes apparent. However, that isn't the only reason the ASBA has become the fastest growing academy in the field of dental sleep medicine. Under the direction of David Gergen, the academy really focuses on a multidisciplinary approach. Having worked for pioneers in orthodontics and dental sleep medicine, David understands what we as dentists treating OSA need to be successful which translates to an overall improvement on patient outcomes and industry advances. Simply putting it, we have an academy fighting on our behalf.
Since 2012, the ASBA has had representatives of the academy meet in Washington D.C. with senators, congressmen and legislatures in charge of rulemaking relating to our field. Oral appliance therapy hasn't been properly recognized as a legitimate treatment option; in my humble opinion the ASBA is about to change all of that. The medical profession has never been truly educated on oral appliance therapy and achieving level ground starts with us dentists obtaining the best possible education.
For example, in our industry we have a very disappointing situation occurring with large companies who grew off the backs of trained and established sleep dentists hiring kids right out of school with no sleep experience and providing a measly nine hours of online education and calling them experts. Our industry has been undermined enough. Dr. Elliott Alpher was first to tell me, "The ASBA is the only sleep academy fighting for the dentists' rights in the OSA arena. The efforts will become stronger as the ASBA grows. The more members we have the more firepower we'll have. I am so pleased that I have joined this academy." I urge any dentist who is interested in sleep medicine to join the ASBA like I did and stand proud.
-Dr. Harry Sugg, DDS
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Types of Health Insurance Plans
With the rising cost of medical treatment, it makes a lot of sense to have some type of health coverage, regardless of age and status in life. When shopping for health insurance, it's important to know a few important things about it first.
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Density functional study of the thermodynamic properties and phase diagram of the magnesium hydride
Publication date: March 2018
Source:Calphad, Volume 60
Author(s): Hasan S. AlMatrouk, Viorel Chihaia, Valentin Alexiev
This paper focuses primarily on the P-T phase diagram determination by considering six polymorphs of magnesium hydride (α - rutile TiO2, P42/mnm, β - cubic modified CaF2, Pa3¯, γ - orthorhombic PbO2, Pbcn, δ' - orthorhombic, Pbca and cubic - Fm3¯m). The Gibbs free energy and other thermodynamic properties were evaluated by DFT-based thermodynamic calculations, within the frame of the quasi-harmonic approximation, for the pressure range 0–10GPa and temperatures between 0 and 1200K. Furthermore, the structural, energetic, and electronic properties of the investigated structures are conversed.
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Reconciling SGTE and ab initio enthalpies of the elements
Publication date: March 2018
Source:Calphad, Volume 60
Author(s): Axel van de Walle
The CALPHAD framework is built on assumption that all phases have a well-defined free energy over all accessible composition, temperature and pressure conditions. Unfortunately, it is common for phases to exhibit mechanical instabilities in at least some range of conditions, thus precluding direct experimental measurements and hindering computational efforts. A pragmatic solution has often been to extrapolate free energies from stable region into the unstable regions, but extrapolations from different systems that share a common phase may not agree and extrapolated free energies can unintentionally lie below the free energy of stable phases. Computational approaches that aim to directly calculate the free energy of unstable phases offer a promising avenue to address these issues. Among them, the recently proposed "inflection detection" scheme lies on a strong theoretical footing. We provide further support for this approach by demonstrating that it yield free energies that agree very well with the widely used SGTE (Scientific Group Thermodata Europe) data for pure elements. This finding suggest that it may be possible to get the best of both worlds: obtain a theoretically justified definition of the free energy of mechanically unstable phases and preserve much of existing empirical standards for the assignments of such free energies.
Graphical abstract
Highlights
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Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Pedro Henrique Quintela Soares de Medeiros, Aldo Ângelo Moreira Lima, Marjorie Moreira Guedes, Alexandre Havt, Mariana Duarte Bona, Luís Carlos Rey, Alberto Melo Soares, Richard Littleton Guerrant, Bernhard H. Weigl, Ila Fernanda Nunes Lima
Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques and we developed four multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes, more severe disease, higher number of VRGs, and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, while S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup-specificity in Shigella spp. and increased bacterial VRGs.
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Antibody test for Legionella pneumophila detection
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Noemí Párraga-Niño, Sara Quero, Naroa Uria, Oscar Castillo-Fernandez, Josune Jimenez, Francesc-Xavier Muñoz, Miquel Sabrià, Marian Garcia-Nuñez
Legionella pneumophila is a ubiquitous, pathogenic, bacterium responsible for Legionnaires' disease (LD). The detection of these bacteria both in environmental and clinical samples is mainly performed by culture plate method which requires up to 10 days to obtain results. Nowadays, there are commercial antibodies against this bacterium, but they have not been tested against all subgroups of L. pneumophila sg 1 or serogroups 1-16 or their cross-reactions with other non-Legionella bacteria. Indeed, many of these antibodies became available when only 8 serogroups of L. pneumophila had been described.We tested 7 antibodies and found that two (Mab 8/5 and OBT) specifically detected all the subgroups of L. pneumophila sg 1, one without cross-reactions (Mab8/5). Moreover, the LP3IIG2 antibody detected almost all serogroups tested with lower rates of cross-reactivity, resulting in a specific sensitive antibody for the detection of L. pneumophila. LP3IIG2 presented higher rate of cross-reactivity against respiratory non-Legionella isolates, thereby contraindicating its clinical applicability.
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Antimicrobial activity of plazomicin against Enterobacteriaceae producing carbapenemases from 50 Brazilian medical centers
Publication date: Available online 10 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Andreza Faria Martins, Larissa Bail, Carmen Antonia Sanches Ito, Keite da Silva Nogueira, Tanise Vendruscolo Dalmolin, Amanda Silva Martins, Jaime Luis Lopes Rocha, Alisa W. Serio, Felipe Francisco Tuon
BackgroundPlazomicin is a next-generation aminoglycoside with activity against Enterobacteriaceae, including carbapenemase-producing Enterobacteriaceae (CPE).ObjectiveThe aim of this study was to evaluate the activity of plazomicin against CPE (Klebsiella spp., E. coli, Serratia spp., Enterobacter spp., Citrobacter spp., Morganella spp., Proteus spp., Providencia spp.) from different Brazilian hospitals.MethodsA total of 4000 carbapenem-resistant Enterobacteriaceae isolates were collected from clinical samples in 50 Brazilian hospitals during 2013–2015. Of these, 499 carbapenem-resistant isolates (CLSI criteria) were selected for further evaluation via broth microdilution to assess for the activity of plazomicin, colistin, tigecycline, meropenem, amikacin and gentamicin. Additionally, the isolates were assessed for the presence of carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaIMP, blaBKC, blaGES and blaVIM) by polymerase chain reaction (PCR). When PCR was positive to blaOXA-48-like, blaIMP, blaGES and blaVIM, the carbapenemase genes were sequenced.ResultsblaKPC was the most prevalent carbapenemase gene found (n=397), followed by blaNDM (n=81), blaOXA-48 (n=12) and blaIMP-1 (n=3). Other genes were identified in only one isolate each: blaBKC-1, blaGES-16, blaGES-1, blaOXA-370, blaVIM-1. One isolate had two carbapenemase genes (blaKPC and blaNDM). 33% of the isolates were non-susceptible to colistin, 24% to tigecycline, 97% to meropenem, 50% to amikacin and 82% to gentamicin (via EUCAST criteria). The plazomicin MIC50/90 was 0.5/ ≥ 64mg/L, with 84% of MICs ≤2mg/L and 87% of MICs ≤4mg/L. Elevated MICs to plazomicin were not associated with a specific carbapenemase or bacterial species.ConclusionThe MICs of plazomicin against CPE were lower than that of other aminoglycosides. Plazomicin is a promising drug for the treatment of CPE infections.
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In vitro activity of tedizolid against the Mycobacterium abscessus complex
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Fabrice Compain, Daria Soroka, Beate Heym, Jean-Louis Gaillard, Jean-Louis Herrmann, Delphine Dorchène, Michel Arthur, Vincent Dubée
Infections due to Mycobacterium abscessus carry a poor prognosis since this rapidly growing mycobacterium is intrinsically resistant to most antibiotics. Here, we evaluate the in vitro activity of the new oxazolidinone tedizolid against a collection of 44M. abscessus clinical isolates. The MIC50s and MIC90s of tedizolid (2 and 8μg/mL, respectively) were 2- to 16-fold lower than those of linezolid. There was no difference between the three M. abscessus subspecies. Time-kill assays did not show any bactericidal activity at 4- and 8-fold the MIC. Combination of tedizolid with clarithromycin was synergistic against 1 out of 6 isolates, while indifferent interactions were observed for tedizolid combined with tigecycline, ciprofloxacin, and amikacin.
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SPM-1-producing Pseudomonas aeruginosa ST277 Clone Recovered from Microbiota of Migratory Birds
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Willames M.B.S. Martins, Ana Clara Narciso, Rodrigo Cayô, Stéfanie Vanessa Santos, Lorena C.C. Fehlberg, Patrícia Locosque Ramos, João Batista da Cruz, Ana Cristina Gales
The production of São Paulo Metallo-β-lactamase (SPM-1) is the most common carbapenem resistance mechanism detected among multidrug-resistant (MDR) Pseudomonas aeruginosa clinical isolates in Brazil. Dissemination of SPM-1-producing P. aeruginosa has been restricted to the nosocomial settings, with sporadic reports of environmental isolates due to contamination by hospital sewage. Herein, we described the detection and molecular characterization of SPM-1-producing P. aeruginosa recovered from the microbiota of migratory birds in Brazil. Three hundred gram-negative bacilli (GNB) were recovered from cloacal and choanal swabs of Dendrocygna viduata during a surveillance study for detection of carbapenem resistant isolates. All isolates were identified by MALDI-TOF MS. Molecular typing was performed by PFGE and MLST. MICs were determined by agar dilution, except for polymyxin B. Antibiotic resistance genes were detected by PCR followed by DNA sequencing. Transcriptional levels of oprD and efflux system encoding genes were also carried out by qRT-PCR. Nine imipenem-resistant P. aeruginosa isolates were recovered with seven of them carrying blaSPM-1. Additional resistance genes (rmtD-1, blaOXA-56,aacA4 and aac(6′)-Ib-cr) were also detected in all nine isolates. The SPM-1-producing isolates showed high MICs for all β-lactams, fluoroquinolones, and aminoglycosides, being susceptible only to polymyxin B. Interestingly, all isolates showed the same PFGE pattern and belonged to ST277. Overexpression of MexXY-OprM and MexAB-OprM was observed in those isolates that did not harbor blaSPM-1. Our results suggest that migratory birds might have played a role in the dissemination of SPM-1-producing P. aeruginosa within the Brazilian territory.
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The effect of a regimen of Antifungal cream use on episodes of acute adenolymphangitis (ADL) among lymphedema patients: An application using marginal structural models
Publication date: Available online 10 November 2017
Source:Journal of Epidemiology and Global Health
Author(s): K.E. Mues, M. Klein, D.G. Kleinbaum, W.D. Flanders, L.M. Fox
Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management.Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding.In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR's were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points.This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies.
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American Sleep and Breathing Academy Members Urged to Call Their Senators
However, the bill is stalled in a committee and needs help from constituents to move it forward before Congress adjourns in December. That's why Drs. Elliott Alpher and Neal Seltzer are calling on their fellow ASBA members to take action by contacting their own Senators to ask that the bill passed out of committee. To streamline the process, please use the toolkit, which contains a sample phone script and letter to your senator. Here is a toolkit to make the outreach by phone or letter easier.
The toolkit consists of a phone script and a letter, which can be easily personalized. Members are asked to call during November to move the bill to action before the end of the year. It would be especially helpful to call Committee Members that have jurisdiction over the measure.
On October 26, 2017, Drs. Elliott Alpher and Neal Seltzer met with representatives of Senator Cory Booker (D- NJ), Senator Kirstin Gillibrand (D-NY) and Senator Debbie Stabenow (D- MI).
ASBA member Richard Klein worked behind the scenes to arrange the meeting with Stabenow who is a member of the influential budget and finance committees.
"We need to reach each member of the Senate," Dr. Neal Seltzer said." We have met with four so far. With the help of the membership, we can contact all the senators."
During their Senate meetings, Drs. Alpher and Seltzer explained the need to have a dental sleep expert appointed to the Medical Review Board. This body sets health guidelines, including the diagnosis and treatment of OSA for transportation workers. Currently there are no sleep medical experts among the five members.
The staffers were especially interested in a letter Dr. Alpher received from the FMCSA in response to his letter to Department of Transportation Secretary Elaine Chao. FMCSA Associate Administrator for Policy, Larry Minor, responded that the agency had decided the current methods of diagnosing and treating OSA among transportation workers are "adequate."
Drs. Alpher and Seltzer also volunteered to provide medical and scientific expertise to the Senators as the legislation works its way through the process.
"In all three offices, we were well received," said Dr. Alpher. "They were genuinely interested in willing to follow-through on our offers to help them gain some certainty for transportation workers."
TOOLKIT
Write A Letter
- FIND THE ADDRESS OF YOUR SENATOR HERE
- Cut and paste the letter below onto your letterhead
- REPLACE the highlighted portions
The Honorable <Full Name>
United States Senate
NUMBER BUILDING
Washington, DC <ZIP>
Dear Senator <NAME>:
My name is <Your Name> and I am one of your constituents and I live in <Your City>.
I am writing to ask for your support for the Senate Bill –– S.1883, to require the Department of Transportation to finish the rule for obstructive sleep apnea diagnosis and treatment among transportation workers.
The importance of safety for both the traveling public and the individual transportation workers cannot be overstated. It seems every day, there is a news report of another fatal accident caused by obstructive sleep apnea. But we need federal uniformity for both transportation workers and the traveling public. There's a bill that's languishing right now in committee and I ask you to support its passage. S-1883 will compel the Department of Transportation to finish the work on a rule that will provide for testing and treatment of obstructive sleep apnea among the nation's truckers and rail workers.
Without federal certainty, people are dying. The National Transportation Safety Board ruled recently that obstructive sleep apnea was to blame for two rail accidents.
Under the current guidelines transportation workers face even more confusing, contradictory and costly for the workers. The Medical Review Board, which sets the standards and trains the certified medical examiners to conduct physicals, has no dental sleep medicine or other sleep professional among its members. We need a dental sleep medical specialist appointed to that board.
There is no one trained in the diagnosis and treatment of obstructive sleep apnea on the board and none of the certified medical examiners have experience in diagnosing the disease. In fact, drivers have said they often receive different results, depending upon the examiner. Then, drivers and railway workers face paying as much as $5,000 out-of-pocket for just one expensive treatment option that offers no guarantees of success.
Right now, as many as 18 million people are living undiagnosed. Those include railway operators and truck drivers, who are at higher risk because they lead more sedentary lives and maintain less regular sleep schedules.
Obstructive sleep apnea is a killer and if you know someone who snores, pay attention. Snoring is the body's warning sign that the person is not getting sufficient oxygen and is at risk for obstructive sleep apnea. It is linked to so many life-threatening diseases such as heart attacks, strokes, high blood pressure, type 2 diabetes, depression, Alzheimer's Disease and even glaucoma. I know you would agree that anything we can do to improve the health and safety of the traveling public and transportation workers is beneficial to all.
I am asking that you call for S.1883 to be advanced in the SURFACE TRANSPORTATION AND MERCHANT MARINE INFRASTRUCTURE, SAFETY AND SECURITY subcommittee.
Thank you for your time and consideration.
Sincerely,
<YOUR NAME>
Make a Phone Call
Phone Script in Support of Senate Bill –– S.1883, to require the Department of Transportation to finish the rule for obstructive sleep apnea diagnosis and treatment among transportation workers
- Find Your Senator
- Call the Capitol Switchboard –– 202-224-3121
- Ask for Your Senator
- When the staffer answers ––
- Ask for the staff member who handles TRANSPORTATION ISSUES
What to Say
Thank you for taking my call. My name is <Your Name> and I live in <Your City>.
I am one of your constituents.
- I am calling to talk to you about the importance of safety for both the traveling public and the individual transportation workers. There's a bill that's languishing right now in committee and I ask you to support its passage. S-1883 will compel the Department of Transportation to finish the work on a rule that will provide for testing and treatment of obstructive sleep apnea among the nation's truckers and rail workers.
- Without federal certainty, people are dying. The National Transportation Safety Board ruled recently that obstructive sleep apnea was to blame for two rail accidents.
- Under the current guidelines transportation workers face even more confusing, contradictory and costly for the workers. The Medical Review Board, which sets the standards and trains the certified medical examiners to conduct physicals, has no dental sleep medicine or other sleep professional among its members. We need a dental sleep medical specialist appointed to that board.
- There is no one trained in the diagnosis and treatment of obstructive sleep apnea on the board and none of the certified medical examiners have experience in diagnosing the disease. In fact, drivers have said they often receive different results, depending upon the examiner. Then, drivers and railway workers face paying as much as $5,000 out-of-pocket for just one expensive treatment option that offers no guarantees of success.
- Right now, as many as 18 million people are living undiagnosed. Those include railway operators and truck drivers, who are at higher risk because they lead more sedentary lives and maintain less regular sleep schedules.
- I don't know whether you know, but obstructive sleep apnea is a killer and if you know someone who snores, pay attention. Snoring is the body's warning sign that the person is not getting sufficient oxygen and is at risk for obstructive sleep apnea.
- It is linked to so many life-threatening diseases such as heart attacks, strokes, high blood pressure, type 2 diabetes, depression, Alzheimer's Disease and even glaucoma. I know you would agree that anything we
- I am asking that you call for S.1883 to be advanced in the SURFACE TRANSPORTATION AND MERCHANT MARINE INFRASTRUCTURE, SAFETY AND SECURITY subcommittee, where it is stuck.
Thank you for your time and consideration.
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The use of an electronic clinical rule to discontinue chronically used benzodiazepines and related Z drugs
Abstract
Purpose
The chronic use of benzodiazepines and benzodiazepine-related drugs (BZ/Z) in older people is common and not without risks. The objective of this study was to evaluate whether the implementation of a clinical rule promotes the discontinuation of chronically used BZ/Z for insomnia.
Methods
A clinical rule, generating an alert in case of chronic BZ/Z use, was created and applied to the nursing home (NH) setting. The clinical rule was a one-off intervention, and alerts did not occur over time. Reports of the generated alerts were digitally sent to NH physicians with the advice to phase out and eventually stop the BZ/Z. In cases where the advice was adopted, a follow-up period of 4 months on the use of BZ/Z was taken into account in order to determine whether the clinical rule alert led to a successful discontinuation of BZ/Z.
Results
In all, 808 NH patients were screened. In 161 (19.1%) of the patients, BZ/Z use resulted in a clinical rule alert. From these, the advice to phase out and stop the BZ/Z was adopted for 27 patients (16.8%). Reasons for not following the advice consisted of an unsuccessful attempt in the past (38 patients), patients family and/or patient resistance (37 patients), the non-continuous use of BZ/Z (32 patients) and indication still present (27 patients). Of the 12 NH physicians, seven adopted the advice.
Conclusions
The success rate of a clinical rule for discontinuation of chronically used BZ/Z for insomnia was low, as reported in the present study. Actions should be taken to help caregivers, patients and family members understand the importance of limiting BZ/Z use to achieve higher discontinuation rates.
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Rotten teeth extractions reveal growth in child poverty, dentists say
Ministry of Health data shows the percentage of Kiwi 5-year-olds found to have rotten teeth at community dental clinics decreased from 49 per cent in 2001 to 40 per cent in 2016. During the same period, children aged 0 to 14 years old requiring general anaesthetic for rotten teeth removal increased from 4500 to 7500 , according to ministry data.
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Closing a Diastema – With Bioclear Matrices
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Knockdown of LncRNA ANRIL suppresses cell proliferation, metastasis, and invasion via regulating miR-122-5p expression in hepatocellular carcinoma
Abstract
Objective
Previous studies reported that lncRNA antisense non-coding RNA in the INK4 locus (ANRIL) was upregulated in hepatocellular carcinoma (HCC) tissues and decreased expression of ANRIL could suppress cell proliferation, metastasis, and invasion and induce apoptosis of HCC cells. However, the molecular mechanism of ANRIL involved in HCC tumorigenesis is still unknown.
Methods
The expressions of ANRIL and miR-122-5p in HCC tissues and cells were quantified by qRT-PCR. MTT assay, colony formation assay, wound healing assay, and transwell invasion assay were performed to evaluate cell growth, metastasis, and invasion, respectively. RNA immunoprecipitation (RIP) assay and luciferase reporter assay were performed to determine whether ANRIL could directly bind to miR-122-5p in HCC cells. Xenograft tumor experiment was conducted to confirm the biological role and underlying mechanism of ANRIL in vivo.
Results
The results showed that ANRIL was upregulated and miR-122-5p was downregulated in HCC tissues and cells. ANRIL was negatively correlated with miR-122-5p expression in HCC tissues. Knockdown of ANRIL or miR-122-5p overexpression suppressed HCC cell viability, colony formation ability, metastasis, and invasion. ANRIL was demonstrated to directly bind to miR-122-5p and inhibit its expression. Forced expression of ANRIL abolished the inhibitory effect of miR-122-5p overexpression on HCC progression. In vivo experiment demonstrated that ANRIL knockdown impeded tumor growth in vivo and increased miR-122-5p expression.
Conclusion
Our finding suggested that knockdown of ANRIL suppressed cell proliferation, metastasis and invasion via regulating miR-122-5p expression in HCC, illustrating the underlying mechanism of the oncogenic role of ANRIL in HCC.
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Vocal fold augmentation under local anesthesia using autologous fascia
Abstract
Vocal fold augmentation by injection of autologous fascia has been used since the 1990s with excellent safety record in 500 operations done under general anaesthesia. It is safe from risks arising from allergic or other foreign body adverse reactions. Fascia provides long-term augmentation and remains stable 3-10 years after injection.
Vocal fold augmentation under local anaesthesia is excellent alternative for those unfit for general anaesthesia, providing aid to fragile and weak persons with vocal fold paralysis. However, all of available synthetic materials resorb within 6-24 months.
Fascia injection under local anaesthesia provides the possibility for a long-term vocal fold medialization while avoiding risk of general anaesthesia. Fascia lata harvesting and processing is easily done (as shown in video) followed by injection into the vocal fold. The whole procedure is done under local anaesthesia. Procedure offers long-term vocal fold medialization, fine tuning the amount of the medialization by immediate feedback from the patient's voice. Operation time is one hour.
This article is protected by copyright. All rights reserved.
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Antı-β2 Glycoprotein I Antibodies in Children with Rheumatologic Disorders
Abstract
Anti-beta-2-glycoprotein I antibodies (anti-β2GPI) which are the main antiphospholipid antibodies that characterize the autoimmune "antiphospholipid syndrome" are pathogenic and are contributing to thrombosis. We aimed to evaluate the presence and the diagnostic importance of these antibodies in children with different rheumatologic diseases with or without thrombosis risk. A total of 100 children with different rheumatologic diseases evaluated retrospectively. The mean anti-β2GPI IgG (p = 0.108), IgA (p = 0.547), and IgM (p = 0.807) levels showed no statistically significant difference between different diagnosis groups. But anti-β2GPI IgA and IgM levels were higher in SLE patient group. The mean anti-β2GPI IgG (p = 0.375), IgA (p = 0.811), and IgM (p = 0.276) levels were not also showed difference between disease groups with/without predisposition to thrombosis even though concentrations were higher in thrombosis group. In children with rheumatological complaints, anti-β2GPI antibody measurements should not be the first diagnostic criteria if vasculitis is not thought as the primary defect underlying the clinical symptoms.
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Tailored resections in oral and oropharyngeal cancer using narrow band imaging
Source:American Journal of Otolaryngology
Author(s): Giancarlo Tirelli, Marco Piovesana, Alberto Vito Marcuzzo, Annalisa Gatto, Matteo Biasotto, Rossana Bussani, Lorenzo Zandonà, Fabiola Giudici, Francesca Boscolo Nata
PurposeIn a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.Materials and methodsThe resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded.ResultsWe obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site.ConclusionsNBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.
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Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses
Source:American Journal of Otolaryngology
Author(s): Bernard Tan, Lee Tee Sin, Ian Loh
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Prevalence of Diabetes Mellitus in People Clinically Diagnosed with Periodontitis: A Systematic Review and Meta-analysis of Epidemiologic Studies
Abstract
Objectives
Diabetes mellitus and periodontitis are complex chronic diseases with an established bidirectional relationship. This systematic review evaluated in subjects with professionally diagnosed periodontitis the prevalence and odds of having diabetes.
Methods
The MEDLINE-PubMed, CENTRAL and EMBASE databases were searched. Prevalence of diabetes mellitus among subjects with periodontitis were extracted or if possible calculated.
Results
From the 803 titles and abstracts that came out of the search, 29papers met the initial criteria.
Prevalence of diabetes was 9.4% among subjects with periodontitis and 12.8%among subjects without periodontitis. Based on sub-analysis, for subjects with periodontitis, the prevalence of diabetes was 6.5%when diabetes was self-reported, compared to 17.3%when diabetes was clinically assessed. The highest prevalence of diabetes among subjects with periodontitis was observed in studies originating from Asian countries(17.2%,n=16647) and the lowest in studies describing populations from Europe(4.3%(n=7858). The overall odds ratio for diabetes patients to be among subjects with periodontitis as compared to those without periodontitis was 2.59(95%CI[2.12;3.15]). A substantial variability in the definitions of periodontitis, combination of self-reported and clinically assessed diabetes, lack of confounding for diabetes control in included studies introduces estimation bias.
Conclusions
The overall prevalence and odds of having diabetes is higher within periodontitis populations compared to people without periodontitis. Self-reported diabetes underestimates the prevalence when compared to this condition assessed clinically. Geographical differences were observed: the highest diabetes prevalence among subjects with periodontitis was observed in studies conducted in Asia and the lowest in studies originating from Europe.
This article is protected by copyright. All rights reserved.
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New dental office opens in Carolina Forest
Ocean Bay Dental Care in Carolina Forest, a full-service family dental practice, is set to open on Nov. 30 in its new building on International Drive. The dental clinic will be operated by dentists Jesse Blair and John Steppe, and staffed to perform routine cleanings and fillings as well as cosmetic services, said a statement announcing the opening.
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Mini-implants and narrow diameter implants as mandibular overdenture retainers: A systematic review and meta-analysis of clinical and radiographic outcomes
Summary
This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for clinical studies that evaluated implants with diameter ≤ 3.5 mm. Data on the MI and NDI for survival and success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective longitudinal (PL) clinical studies and 7 randomized clinical trials (RCT) with follow-up periods ranging from 1 day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used both loading types and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6 PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used conventional loading, 1 study used immediate loading and 1 study did not report. The average survival rates of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and 96%, respectively. The average peri-implant bone loss after 12, 24, and 36 months was 0.89, 1.18, and 1.02 mm for MI and 0.18, 0.12, and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behavior as overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies adopting conventional loading.
This article is protected by copyright. All rights reserved.
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